In a longitudinal study of 813 Dutch children born at less than 32 weeks gestation or with birth weights less than 1,500 grams, at age 9 years children born preterm had more school-related problems than the general Dutch population: 32 and 14 percent, respectively, functioned below grade level; 38 and 6 percent, respectively, received special education assistance; and 19 and 1 percent, respectively, were in special education classes (Hille et al., 1994). In adolescence (age 14 years), 27 percent received special education services, whereas 7 percent of their peers received special education services (Walther et al., 2000).

By early adolescence, the children who had been born preterm with birth weights of less than 1,000 grams were 3 to 5 times more likely than the controls born fullterm to fail a grade and required 3 to 10 times more special education resources than the controls born fullterm (Klebanov et al., 1994; Saigal et al., 2000c; Taylor et al., 2000). Saigal and colleagues (2005b) found progressive increases in school problems with decreasing birth weight category: 13 percent for fullterm controls, 53 percent for children born with birth weights between 750 and 1,000 grams, and 72 percent for children born with birth weight less than 750 grams. The proportions of children who had been born with birth weights less than 1,000 grams and who were in regular classrooms without grade failures or special education resources were only 42 to 50 percent at 8 to 10 years of age and as low as 36 percent at 18 years of age (Halsey et al., 1996; Klebanov et al., 1994; Lefebvre et al., 2005; Saigal et al., 2000c).

Many difficulties in school reflect the presence of learning disabilities, which become more apparent as children who had been born preterm progress through their education. A specific learning disability is a term that refers to a heterogeneous group of disorders of one or more of the basic psychological processes involved in understanding or in using spoken or written language. These disorders may manifest as significant difficulties with the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical skills. The diagnosis of a learning disability requires comparisons of performances on tests of academic achievement, cognition, language, visual motor integration, and perceptual abilities. Although the incidence of learning disabilities varies depending on how they are defined, most estimates indicate that 10 percent or less of the general population has evidence of a specific learning disability.

Ample evidence suggests that many more children born preterm have specific learning disabilities than children of normal birth weight born fullterm. By school age, despite normal intelligence, children born with birth weights of less than 1,000 or 800 grams have a 3- to 10-fold increased risk of problems with reading, writing, spelling, or mathematics compared with the risk for their peers who had been born fullterm (Aylward, 2002a; Grunau et al., 2002; Hall et al., 1995; O’Callaghan et al., 1996; Ornstein et

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